Elliot Benjamin is a philosopher, mathematician, musician,
counselor, writer, with Ph.Ds in mathematics and psychology and the author of over 150 published articles in the fields of humanistic and transpersonal psychology, pure mathematics, mathematics education, spirituality & the awareness of cult dangers, art & mental disturbance, and progressive politics. He has also written a
number of self-published books, such as: The Creative Artist, Mental Disturbance, and Mental Health. See also: www.benjamin-philosopher.com.

THE PERSON VS THE PILL

AN INTEGRATIVE PSYCHOTHERAPY PERSPECTIVE

Elliot Benjamin

It is very basic knowledge that everyone these days knows that if you are feeling depressed or overly anxious, then there is medication you can take that will make you feel better. All you need to do is to visit your local psychiatrist or medical doctor, and if you are lucky enough to have access to or be able to afford good health insurance then it appears that your pills to happiness are on their way. Well--your pills may be on their way, but I must state that in my opinion your medicated happiness is a deceptive maneuver indoctrinated in you by our greedy materialistic technological society. For the preposition “your” implies that there is a “you” inside there; i.e. a real live authentic person who exists in the world. This “you” is without doubt faced with overwhelming unavoidable existential conditions, the most challenging of which I believe is your eventual death. But this “you” may very well also have access to some bona-fide transpersonal wisdom, such as the possibility of deep spiritual awareness. I like to think of the combination of existential reality and transpersonal awareness blended together in the realm of humanistic personhood, as envisioned by the founders of the humanistic psychology movement in the early 1960s: Carl Rogers and Abraham Maslow (Rogers, 1961, Maslow, 1962).

Humanistic psychology places emphasis upon a person's feelings, thoughts, desires, ambitions, dreams, fears, etc. in the context of a nurturing, authentic, therapeutic relationship that facilitates both personal awareness and personal growth. Rogers talked about “unconditional positive regard” and Maslow talked about “self-actualization” (Rogers, 1961, Maslow, 1962). As formulated by Carl Rogers, from an inner exploration of the self in the presence of a caring and genuine therapist, perhaps feelings of depression and anxiety could lead to awareness that one's present life choices are not congruent with one's deeper potential of self (Rogers, 1961). The extension of this humanistic perspective into a broadened Humanistic/ Existential/ Transpersonal perspective could even be combined with the dominant current American psychology focus of Cognitive and Behavioral psychology to formulate a creative and integral blend of effective psychotherapy, an example of which I believe can be found in Acceptance And Commitment Therapy, as formulated by Steve Hayes (Hayes, Strosahl, Wilson, 1999). In Acceptance And Commitment Therapy (abbreviated as ACT Therapy), the main premise is that difficult feelings such as depression and anxiety need to be accepted while the deeper self and higher values are contacted, complete with a behavioral plan to achieve one's higher level goals in life (see my previous Integral World essay: “An Integrative/Non-Integral Psychotherapy Model” (Benjamin, 2007).

But what happened to the pill? What happened to the necessary medication to alleviate these dreadful unwanted states of depression and anxiety? According to ACT Therapy, the answer is that these states need to be accepted as part of your life while you learn to put your deepest intentions into your highest callings, regardless of whether or not you are taking any medication for depression or anxiety (Hayes, Strosahl, Wilson, 1999). Perhaps your depression and anxiety will diminish as you live your life more authentically; perhaps they will remain with you. But the point is that you are shifting levels of life awareness; shifting into a higher experiential level that borders on the transpersonal realms of deep meditation and experiential spirituality. This shift in the experience of the person is consistent with the pioneering visions of Rogers and Maslow, and is also consistent with the existential awareness visions of Rollo May, Jim Bugental, and Irvin Yalom (Bugental, 1965, May, 1969, Yalom, 1980), and the higher levels of consciousness visions of Ken Wilber, Roger Walsh, and Charles Tart (Tart, 1975, Wilber, 1995, Walsh, 1999). I believe this can be summed up simply as the person is trading in the pill for the sacred awareness of his/her own existence; or as Shakespeare said: to be or not to be.

However, I am in the process of learning that perhaps Psychopharmacology does not have to be as contradictory to authentic personal awareness and growth as I have thus for portrayed it to be. Perhaps psychotropic medications can be utilized as temporary relief that enables a person to truly make headway in exploring the Humanistic/ Existential/Transpersonal realms that I have been describing. Perhaps what is most important here is that even though it is not my way of personal growth, it appears that the only possibility for the survival of Humanistic psychology is to blend itself into the psychological mainstream in truly integrative fashion, as initially described in the many insightful articles in “The Handbook Of Humanistic Psychology” (Schneider, Bugental, Pierson, 2001) and the descriptive case studies in “Existential-Integrative Psychotherapy” (Schneider, 2007). This extensive Humanistic psychology integration has incorporated various Behavioral, Cognitive, and Psychodynamic psychologies, and there have also been perspectives in the context of Ken Wilber's Integral Theory applied to Integral Psychology and Integral Psychiatry that have included Psychopharmacology into an entire mix of psychotherapeutic treatments (Wilber, 2000, Bearer, 2007, Zeither, 2007). However, I have previously described my own viewpoint that a completely “equalitarian” assimilation of all the diverse psychotherapy disciplines leaves something to be desired (see my previous Integral World essay: “Integral With A Twist” (Benjamin, 2007)). But as I continue to extend my present involvement as a mental health worker and counselor trainee in our current mental health medical model managed care system, it becomes more and more clear to me that the pill is here to stay, and the integrative humanistic practitioner (with a twist) somehow needs to assimilate the pill without succumbing to it; in other words, the person must swallow the pill and still “be.”

To give a bit of personal motivation for my interests in this whole topic, I can remember how much impact the movie “One Flew Over The Cuckoo's Nest,” based upon Ken Kesey's book of the same title (Kesey, 1962), had upon me when I first watched it in the movie theatres nearly 40 years ago. As I have described in my book “Art And Mental Illness” (Benjamin, 2006), my personal exposure to the dehumanizing effects of excessive psychotropic medication stems from my growing up with an older brother who spent most of his adult life in and out of mental hospitals, diagnosed with bipolar disorder and given a multitudes of medications, restraints, and shock treatments. I often wondered how different my brother's life may have turned out if he had been seen by a humanistic therapist who related to him in a caring, authentic, non-medical therapeutic context when he was in his formative growing up years before his first severe depression and suicide attempt that led to his first mental hospitalization. My “Art And Mental Illness” book is dedicated to my brother, and my decision to do a late in life career change from mathematics professor to counselor and psychologist is largely due to the lifelong involvement I had with my brother. I somehow never could accept that my brother had a psychological “illness” that could be cured if one could just find the right medication to give him. And my inclination to not accept the traditional medical model of mental disturbance was tremendously reinforced when I came upon the radical psychotherapy ideas of Thomas Szasz and R.D. Laing (Szasz, 1962, Laing, 1967, Benjamin, 2008). To give a very brief description of these ideas, one could say that Laing asked what sense it makes to decide who is normal and who is abnormal when we ourselves live in an insane society where psychosis may be the preliminary misguided emergence of a person's creative potential (Laing, 1967), and Szasz has written numerous books over a span of nearly half a century to dispel the whole medical model that portrays mental disturbance as mental “illness.” (Szasz, 1974). However, the fact remains that the present day realities of the managed care mental health society in which we live operate completely by the medical model of mental disturbance, with a primary focus of using various psychotropic medications to combat mental “illness.”

I thus find myself in quite the mental health counseling dilemma. In my initial experience as a counselor intern this past summer, I witnessed children as young as 3 and 4 years old being given various medications based upon their DSM IV diagnosis of ADHD (Attention Deficit/Hyperactive Disorder) and Autism (American Psychiatric Association, 2000). For older children the list of medications they were taking were incredibly extensive and used in a number of different combinations. Within myself I questioned the necessity of all this medication being given to the children, but I realized that I was in no position to change the system, and the best thing I could do was to accept the medication and diagnostic status quo while relating to the children therapeutically in as humanistic a capacity as I was able to. My current community based mental health program, in which I am working once again as a mental health worker and counselor trainee, is heavily oriented toward a Behavioral psychology approach, but there is also a strong humanistic non-medical strength based foundation of perceiving clients in a personally involving, caring, and growth oriented context. The DMS IV diagnostic criteria is accepted as part of our jobs, a necessity of working with the state and getting paid, but our clinical supervisor continuously stresses that our clients are people first and that the DMS IV criteria should not be given undue emphasis. In regard to the prescribed medications that go along with the DMS IV classifications, my agency appears to take a neutral stance. The medication requirements are accepted, but we as mental health workers are not involved in discussing these medications with clients or their families, much less giving them out to clients. Rather our focus is upon behavioral programming in the context of humanistic caring. I see this as a good example of “Humanistic Behaviorism” and Integrative Psychotherapy, a category in which I would also put ACT Therapy.

Are there occasions where I believe it is appropriate to give clients psychotropic medications? I would answer “Yes” there are circumstances in which medication as well as restraints are appropriate and necessary to insure the client's safety and the safety of those working closely with the client. However, I would also say that the underlying humanistic context of therapeutic caring and authenticity does not need to be compromised in these circumstances. I have described such a humanistic restraint procedure in my “Art And Mental Illness” book (Benjamin, 2006) and I recently witnessed an intensive episode that came very close to violence involving one of my current adolescent clients. In this situation I must admit that I was very glad to see that medication was a viable and effective option. I am therefore not saying that there are no circumstances in which psychotropic medications in mental health treatment may truly be beneficial to clients. I can well understand how medication can be effectively utilized to enable for example a client overwhelmed by anxiety, or a client obsessed with paranoid delusions, to enter a more conducive state of mind to be able to receive benefit from the kind of integrative humanistic psychotherapy that I have been advocating. The main problem I have is with the excessive and indiscriminate use of psychotropic medications as a “substitute” for authentic growth oriented psychotherapy. Taking a pill to “feel better” I do not believe is a justifiable end in itself. But taking a pill to enable one to work on oneself in an integrative humanistic therapeutic context I believe is a reasonable therapeutic activity to engage in. I would add that my own personal/professional perspective is that part of the therapeutic goal should be to eventually reach a point where this pharmacological assistance is no longer needed.

In conclusion, in regard to the person vs. the pill, perhaps the situation has possibilities of peaceful coexistence after all. Perhaps the person can swallow the pill in such a way that it actually enables him/her to “be,” and to eventually reach a point where the pill may no longer be needed. Certainly in the mental health context in which I have now chosen to work I think this is a sensible and viable perspective for me to adopt. But in my own personal life I still have no interest in allowing Psychopharmacology to enter my way of being. I have always been on a path of self awareness and spiritual exploration, and I do believe that this is in keeping with our natural human capabilities to accept the psychological challenges of life, relying upon our own natural inner strengths. But this is me; and I recognize that I am far removed from the mainstream of my society, and what works for me may very well not work for the vast majority of people living in my society. I can describe to people my own ways and I can be open to a modified view of medication (temporary if feasible) in the context of therapeutic humanistic growth. With a bit of luck, I will be able to walk the integrative humanistic/medication tightrope and find my place in the world of professional humanistic psychotherapy in the context of our current mental health medical model managed care system in the society in which I live.